2021_Book_TextbookOfPatientSafetyAndClin

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support safe and effective use of medication by
providing readily accessible information on medications
and potential ADE for both patients and
healthcare professionals.
31.2.3.3 Patient Engagement
and Education
Navigating the complicated processes in transitions
of care, especially across settings, requires
high level of health literacy and active involvement
from patients and their families or caregivers
[21–23]. This is essential as they are the only
constant in their respective healthcare journeys,
and those with low health literacy will face challenges
to identify and voice discrepancies in their
medication list during care transitions.
As being inadequately educated regarding
their medications increases the risk of ADEs or
suboptimal therapy, various actions can be taken
by healthcare professionals to engage and educate
patients. For starters, healthcare professionals
should ensure that all patients as well as their
immediate families or caregivers are made aware
of changes in their medication, the monitoring
needs and whom to contact should problems
arise during transitions of care [13]. This can be
done by properly engaging and counselling them,
especially during discharge from hospitals,
including asking whether they understand what is
being communicated.
Other strategies include developing standardised
discharge instructions for patients, creating
or updating patient-held medication list
with rationale for changes in therapy stated and
follow-up needs specified. This comprehensive
medication list can also increase their understanding
about their medical conditions as well
as the indication of each medications, how to take
them, what side effects to expect and when they
should seek help.
31.2.3.4 Monitoring
and Measurement
Successful implementation of transitions of care
interventions requires extensive coordination and
communication between healthcare providers
from different institutions. Various interventions
can be put to trial to improve transitions of care,
but they have to be adequately monitored and measured
to determine their efficacy in reducing medication
discrepancies and avoidable patient harm.
Various standardised outcome measures are available,
for instance process measures for the quality
and effectiveness of medication reconciliation
such as outstanding unintentional medication discrepancies
and percentage of patients receiving
medication reconciliation [13]. In addition, validated
survey instruments for patient-centred measures,
such as patient experience and understanding
of medications, are also recommended to achieve
a well-rounded evaluation [16, 24, 25].
31.3 Medication Safety
in Polypharmacy
H. C. Soon et al.
In order to have a rough estimate of the prevalence
of polypharmacy, it is necessary to understand the
definition of polypharmacy first. In its most simplistic
definition, polypharmacy means “an individual
on multiple medications” [26, 27]. This
usually afflicts those with numerous chronic health
conditions, and is highly prevalent in the elderly as
the number of co-morbidities increases in tandem
with age [28, 29]. Individuals with polypharmacy
often consult more than one medical specialist and
have prescription medications filled at multiple
pharmacies, making their medication regimen
complex. This is further complicated by usage of
non-prescription as well as traditional and/or complementary
medications [28].
There is however no exact definition for polypharmacy.
It is often defined as taking five or
more medications, but other numbers were also
used as the cut-off point [30]. This numerical
definition is criticised as being arbitrary, as the
number of medications taken lacks correlation
with patients’ clinical outcome. In fact, the use of
multiple medications is warranted and rational in
some health conditions, for example, heart or
renal failure. This rational polypharmacy is contrary
to the negative connotation associated with
the term, where it is used to describe duplication
of therapy, presence of drug interaction, nonindicated
or excessive use of medicines [31, 32].
Hence, proponents now advocate for a distinction